Childhood Trauma: Causes, Signs, Therapy

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S

Trauma

Trauma means injury (not essentially physical) of damaging impact. When related to the body, they may denote physical injury. When pertaining to the mind, it would denote untoward experiences.

Other meanings of trauma

• Shock
• Distress
• Pain
• Suffering
• Strain
• Disturbance
• Upset
• Ordeal

Defining a traumatic event

Any event which is violent, frightening or dangerous which tends to pose a threat to the life or bodily integrity of the child is defined to be a traumatic event. The child may have experienced the event or witnessed the event happening to his or her loved ones.

Strong emotions and physical reactions are initiated after these traumatic experiences. They can persist for long time after the event has occurred.

Effect – the child may suffer from –

Mental reactions –

Physiological reactions –

• vomiting
• loss of bowel control
• loss of bladder control
• pounding of heart etc

The danger or traumatic experiences may be found inside the home or from outside also. Fear and other experiences also engulf the child when he or she knows about those experiences coming their way but finds it difficult to protect themselves or face those events. On long term basis this may affect the mind and body of the child. The dangers coming from outside could be a car accident, natural disaster, community violence or any incident like bullying at school. From within the family domestic violence, physical or sexual abuse or unexpected death of a loved one leads the list of causes.

What is childhood trauma?

Childhood trauma is an untoward, aversive or distressing event or events experienced by a child. These events are violent, life threatening or dangerous. These experiences evoke fear, shock, pain or trouble in the child. The other name of childhood trauma is ‘adverse childhood experiences’ or ACEs.

All children do not experience the same kind of trauma. It may be different for different child. The experiences related to and leading to trauma are also differing from child to child.

Examples –

• Experiences that live long with the child and carry into adulthood – physical or sexual abuse
• Onetime events that can take a psychological toll and impact for varying periods of time – loss of loved one, major medical incident, a road accident, natural disaster etc
• Ongoing stress – being bullied as in school or living in a dangerous neighborhood
• Indirect – constantly being in an environment and watching a loved one suffer from a major health issue, violent media etc
• Disturbing experience but need not be traumatic – parental divorce might affect a child in the long run but need not be traumatizing in impact

These experiences can affect the child’s ability to function and cope. It is estimated that approximately 46% of children experience trauma at some point in their young lives. It is important to note that childhood trauma would have a lifelong effect.

Experiences that might be traumatic for a child – a gist

• physical abuse
• sexual abuse
• psychological abuse
• neglect
• natural disasters
• technological disasters
• family violence / witnessing or experiencing domestic violence
• living with a parent or caregiver with significant mental illness
• parental incarceration
• community violence
• terrorism or mass violence
• shootings or violence at school
• discrimination
• racism (institutional racism in schools or communities)
• substance use disorder
• serious accidents
• life threatening illness
• deployment
• being refugee
• war experiences like torture
• traumatic separation
• sudden / violent loss of loved ones / caregiver due to various circumstances

Can children be immune to these experiences?

The child is said to learn the line of difference between what is safe and what is unsafe in this world through his or her experiences and this happens parallel with children’s brain. The child can get immune to these traumatic experiences and prefer to be sage by developing ways of protecting self from what it deems to be unsafe. Self protection and the ways to do that the child chooses would be detrimental in shaping their adult personality.

On the other hand all children cannot do this. This needs courage and choice backed up by matured thinking. It is important to make out when a child would need professional help to deal with his or her trauma. Early intervention and isolation / separation of the child from the zone of these experiences can prevent the ongoing effects of the trauma passing into the adulthood.

Impact of Childhood Trauma

Traumatic events and experiences in the life of a child affect the brain development. This might have lifelong consequences. The impact would be many folds. They may lead to severe impact on physical health, mental health, relationships and social life.

1. Impact on Physical Health

Traumatic experiences may lead to impairment in physical development of the child. Development of central nervous system and immune system are impaired. The child would be at a higher risk of developing chronic diseases in the adult life or in later part of life when he or she would face more adverse traumatic experiences in childhood according to a study published in American Journal of Preventive Medicine (2015) i.e. more the traumatic experiences, more the risk of chronic diseases in adulthood.

Exposure to repeated traumatic experiences in a child would increase the risk of developing diabetes, asthma / pulmonary diseases, stroke or coronary heart diseases / cardiovascular diseases, autoimmune diseases or cancer or increasing levels of pain in adulthood / in later part of life.

2. Impact on Mental Health

Childhood traumatic experiences can lead to psychological effects including depression, emotional distress, anger issues, immense stress, psychotic disorders and PTSD. Complex traumas may also lead to dissociation. Dissociation is where the child would have memory gaps or loss of memory of some experiences. The child would separate himself or herself from the experience mentally. They would imagine themselves to be outside their body and watching their bodies from some other place.

It is also found that in the adults who have experienced traumas in their childhood there would be significantly higher prevalence of ‘suicide attempts’. These bitter experiences would include parental domestic violence, or being a victim of physical or sexual abuse as a child.

3. Impact on Relationships

A child who would have experienced trauma in childhood will have trust issues in relationships including with their caregivers (parents, grandparents, adults belonging and not belonging to family etc). They would strongly believe that the world around them is a scary place to live and people surrounding them are dangerous. They would also lose up on managing their emotions and do not interact positively with the people and world around them. This will prevent these children to form and maintain relationships even when they grow up into adults. In adulthood these children would also struggle with their romantic relationship and will be a part of less satisfying marriages. On the other hand these individuals might also feel that they might not be capable of having healthy and nurturing relationships.

These people will have difficulty in trusting, being vulnerable, giving benefit of doubt, communicating with partners and seeing their partner as ally. They would maintain physical and verbal distant.

4. Other impacts

Below said are the impacts of adverse childhood experiences –

• increased risk of becoming a criminal offender by the age of 35 years committing serious and violent offenses / crimes (according to some studies)
• finding it trouble to solve problems or in reasoning
• inability to plan ahead of an event
• inability to prepare for the future / future events
• increased self harming tendency
• deficit impulse-control
• getting involved in high risk behaviors (rash driving, indulgence in unsafe sex)
• having low self esteem
• having more intense reactions
• reduced ability in parenting in future life

Childhood Trauma and PTSD

PTSD i.e. Post Traumatic Stress Disorder is one of the various reactions seen in children towards traumatic events and experiences. We should note that all exposures to trauma need not lead to a PTSD diagnosis. On the other hand, PTSD can occur in any child, who has experienced trauma, be it a single or series of events. These would carry over into adulthood many times.

Following a traumatic event it is estimated that about 15% girls and 6% boys develop post-traumatic stress disorder (PTSD).

Impact of PTSD in children with childhood trauma –

The child with PTSD following traumatic events / childhood trauma would –

• re-experience traumatic events repeatedly in their minds
• might avoid anything that would remind them of the trauma or
• re-enact the trauma
• become hyper-vigilant (in looking for signs of something bad happening again) to prevent future traumas
• have trouble focusing
• suffer from depression or anxiousness
• have increased anger or aggression
• find it difficult to gel with others or being affectionate with others
• have trouble sleeping
• lose interest in the same activities and things that they used to enjoy previously
• have issues at school
• not know what is real and what not
• be detached, non-responsive to anything or numb
• worry that they might die young
• act younger than they are

In spite of the child not developing PTSD from he or she may still exhibit some behavioral and emotional issues (following a traumatic experience) during initial weeks and months including anger issues, irritability, attention problems, loss of interest in normal activities, development of new fears, sadness, appetite changes, increased concerns about safety and death, sleep issues, school refusal, headache, stomachache etc.

What determines development of PTSD in traumatized children?

Whether a child develops PTSD or not mainly depends on the duration and severity of trauma to which the child has been exposed in conjunction with protective factors (whether or not the child has safe and supportive surroundings).

Signs and Symptoms of Traumatic Stress in Children

The signs and symptoms of PTSD may vary greatly from children to children. Any changes in behavior, eating or sleep patterns and academic performance should be regularly observed in children who have undergone traumatic experiences. The most important signs and symptoms are –

• behavioral changes
• avoiding activities that he or she used to once enjoy doing
• difficulty in focusing – trouble in focusing on the same situations which were once easy to do
• overacting to situations
• anxiousness / constant worry
• increased sadness
• intense fear
• volatile emotions
• isolation / hyper independence
• avoidance of certain things, people, places
• hyperactivity
• problems with authority figures
• changes in academic performance
• changes in appetite
• sleeping difficulties

Factors determining the response to traumatizing events –

• age of the child
• developmental level
• support system
• experiences

Risk and protective factors

Traumatic events will not always develop into traumatic stress. Certain protective factors at personal level (of the child), family and community levels can reduce the adverse impact of trauma.

Below mentioned factors need to be considered –

Risk Factors

Severity and seriousness of traumatic event (to self or loved ones)

Proximity of the traumatic event (whether the child was at the place of event, how far or how near) – was the event seen, heard or experienced is detrimental

Reaction of the caregivers to the experiences of the child – did they believe, did they take the child’s reactions seriously, what was their response, did they personally cope up etc

Previous history of trauma – continuous exposure to traumatic events is risk factors for traumatic stress reactions to develop

Protective Factors

Family and community factors – play an important role in providing the necessary protection, buffer and cure for the impending traumatic experiences or the experiences that the child has undergone. The families and the communities around the child, the culture, race and ethnicity of the children and their families would be a protective shield to them. These children and their families would have qualities and resources which act as buffer against the harmful effects of traumatic experiences.

Cultural identity of the child also has a positive impact. They determine how the children and their families respond, recover and heal from traumatic experience / experiences. On the contrary the experiences of racism and discrimination act as risk factors for the development of traumatic stress symptoms.

Types of Trauma

Emotional Abuse – abuse, isolation, discretion, humiliation, growing up in an emotionally abusive household or being in relation with emotionally abusive individuals etc

Bullying – is a kind of repeated and habitual harassment, unprovoked physical or psychological harm done by others with an intention of harming, the targets are often those having less physical or social power. It can happen in person or online (nowadays). Bullying is said to be a risk factor for the development of eating disorders, and physical problems like diabetes, heart disease, mental health issues (like anxiety, depression, PTSD, substance abuse, panic disorder etc) and inflammation.

Community violence – it is not a direct form of violence. This trauma is a result of exposure to violent acts and behaviors in the community, continuously and over a period of time. These acts include riots, police brutality, school shootings or gang violence. They may result into academic problems, substance abuse and ideas of suicide. On the other hand these children who have witnessed these types of violence consistently show higher levels of aggression in different phases of childhood and adolescence.

Complex trauma – This occurs from exposure to multiple and repeated exposure to traumatic events or episodes of victimization. These people often display a wide range of difficulties in comparison to those who have experienced a single episode of trauma.

Disasters – Exposure to disasters is highly painful and stressful experience for anyone. It causes a risk factor for poor psychological health. The disaster may be in the form of natural disasters, man-made disasters, loss of loved ones, homelessness and hardships effecting from disasters etc.

Intimate partner violence – This is also not a direct violence. It is caused due to exposure to violence afflicted on his or her family members, loved ones or caregivers. This may be accompanied by direct physical and emotional abuse of the child. The results of these would include behavioral disorders, psychological distress; difficulties related to social interaction and disorganized attachment. These children may also suffer from long term mental health issues.

Medical trauma (Pediatric Medical Traumatic Stress) – comprises of responses of children (and their families) to pain, injury, and illnesses of serious kind, medical procedures, and invasive / frightening treatment experiences.  In short, it is a response to a single or multiple medical events.

Physical abuse – comprises of physical injury or trauma caused by hitting, beating, slapping etc. Injuries range from bruises to broken bones, fractures to even death, cognitive or intellectual disabilities, deficits in social skills, PTSD, severe aggression, anxiety, suicidal behavior, low self esteem, trust issues, anger, depression, substance abuse, interpersonal difficulties and other psychiatric disorders.

Refugee trauma – childhood trauma related to refugee situation may be due to displacement, transitions or resettlement and is also related to war, violence or persecution related trauma which would impact the child’s mental health immensely. Behavioral problems, PDSD, mood disorders, adjustment difficulties and anxiety disorders are a few outcomes of such trauma.

Separation trauma – Separation for a long time from loved ones or caregivers can be extremely painful and traumatic to a child. Separation trauma is a disturbance in attachment relationship. This disrupts neurological development. It can also lead to death.

Sexual abuse trauma – child sexual abuse is yet another common cause for childhood trauma. 

Traumatic grief – In this the child will not be able to cope up with daily life due to trauma related grief.

What happens when childhood trauma is not addressed / treated?

Childhood trauma should be promptly addressed. If not treated the unresolved issues related to traumatic experiences will take deep root and can be experienced for long term.

The possibility of preventing untoward / negative consequences related to trauma shall be limited in untreated cases. Example – studies have shown greater glucocorticoid resistance which is usually associated with depression in people with untreated childhood trauma.

How to help the children who have experienced ‘childhood trauma’ (and PTSD)?

How to help the child?

The first step in helping the child who has undergone traumatic experiences / events is to take him or her to a pediatrician to assess the symptoms and to rule out a physical or medical illness. Once the physical causes are addressed, the parent or caregiver should seek out mental health services to support the child. Child and adolescent counselors may be the game changers here. Even among the mental health provider it is better to find someone who really has expertise in trauma-informed care specializing in children and adolescents.

Below mentioned are important ‘child help’ tips –

• Social support is the key strategy to reduce the impact of traumatic experiences which had occurred during childhood. The goal of such support is also to reduce the idea of suicide in these individuals.
• Encourage – counseling and discussion should be held with children needing help and the child should be encouraged to talk and emote.
• Help – the child should be helped and made to understand that what they are undergoing is not their fault.
• Be patient – while treating these children the physicians / healthcare providers should be patient and not push things too hard since every child is different and may take their own time and pace to recover from their condition.
• Reply – the questions of these children if any would be replied honestly.
• Daily routine – one should stick to a daily routine as far and as much as possible.
• Reassurance – the child shall be reassured that he or she shall be kept safe at any cost.
• Referral – the child may be referred to family therapy, cognitive behavioral therapy or play therapy or to any helpful sources as and when needed.
• Medicate – medicine will be required to treat the symptoms in conditions like PTSD associated with childhood trauma.
• Help – there are some reputable organizations like ‘Disaster Distress Helpline’ offered by the SAMHSA (Substance Abuse and Mental Health Services Administration) shall be reached out for help.
• Talk Therapy – will involve speaking to a licensed therapist to get relieved from trauma.
• Online Treatment for PTSD – Talkiatry provides personalized care from psychiatrists who would listen.

Lifestyle Changes

The main goal in implementing lifestyle changes is to avoid ‘similar trauma experiences’ in future days and also to secure the child. This shall be done after getting the child into confidence and trust, with the help of mental health professionals. Below mentioned changes in lifestyle may be good additions to a treatment plan –

• encouraging the children to indulge in activities that bring them joy and forget the previous traumatic experiences
• encouraging children to indulge in good physical exercises
• help the children to identify people who are a part of their support system and encourage them to spend good time in their company
• help children to reframe their negative thoughts
• making sure that the child gets good and enough sleep
• teaching the children relaxation techniques which are appropriate for their development which includes positive visualization, deep breathing techniques, yoga and meditation, positive affirmations etc
• give practice of eating healthy and energetic foods

Other ways to help / Role of parents and caregivers

• As a parent or caregiver, one should be well informed about the childhood trauma, related conditions and their consequences on the child, and the ways in which they can help and deal with them and help themselves in coping up with these situations
• Be aware about what triggers your child’s trauma
• Taking the child to a licensed and experienced professionals / mental health therapist
• Making sure that the child takes medicines as prescribed on regular basis
• Giving emotionally safe space to the children so that they can express themselves while dealing traumatic situations
• Parents or caregivers too shall seek out mental health support from professionals as and when needed to cope up with these situations
• Collaborating with the child’s school and ensure appropriate academic support, and keep informed about bullying or any social and emotional stressors the child is facing in the school

Treatment of Childhood Trauma

Psychosocial and Pharmacological Treatments are helpful to great degree amongst other treatments. Trauma-focused cognitive behavioral therapy is said to be the most effective treatment for childhood trauma.

1. Psychosocial Treatments

Cognitive Behavioral Therapy (CBT) – Being the best treatment for PTSD, CBT helps in changing the thoughts, beliefs and attitudes so that the patients may control their emotions in a better way. It also helps the patients to cope up with the trauma and will help them to improve their problem solving skills.

Trauma focused cognitive behavioral therapy (TF-CBT) – is specially designed to treat PTSD cases in children and adolescents. It is a combination of principles of CBT and trauma-sensitive approaches. It helps in easing symptoms of trauma for both child and parent. It is one of the most effective treatments to reduce the negative psychological effects of childhood trauma, mainly PTSD.

Child and Family Traumatic Stress Intervention (CFTSI) – Apart from reducing the PTSD symptoms it aims at supporting the parents and caregivers by increasing communication amongst them. It also provides healthy coping strategies for children.

Attachment, Self Regulation and Competency Framework (ARC) – is designed for children and adolescents impacted by complex trauma. This is said to reduce behavioral problems and symptoms of PTSD.

Narrative Exposure Therapy (NET) – This involves the children and asks them to recount life events but mainly focusing to bring into focus the positive thoughts of self. It involves reframing trauma in a way that allows someone to contextualize the traumatic experiences. This is done with an intention to decrease the empowerment of trauma on the child’s life.

Dialectical Behavior Therapy (DBT) – This therapy helps to prevent self-harm and enhances interpersonal functioning using a combo of cognitive behavioral and mindfulness techniques.

Real Life Heroes(RLH)  – is programmed for complex PTSD and focuses on –

• regulation of affections
• emotionally supportive relationships
• life story integration

A study shows that it is effective in reducing PTSD symptoms and improving behavioral problems.

Sensorimotor Psychotherapy – The aim of this therapy is to address and heal the ongoing physical and mental / psychological difficulties related to trauma. This is done by integrating body movement into traditional talk therapy.

Eye movement desensitization and reprocessing therapy (EMDR) – It helps in processing traumatic memories and is also an effective treatment for PTSD.

2. Pharmaceutical Treatments

The medications for treating childhood trauma are mainly focused on treating PTSD which usually results from the former. In this direction SSRI (Selective Serotonin Re-Uptake Inhibitors) and anti-depressants are commonly used. According to studies psychosocial therapies have an advantage and are more effective in comparison to the medications. When paired with CBT they are shown to be effective.

Prognosis of Childhood Trauma

Trauma affects all children, at all age groups, due to different causes and in different ways. Some children develop significant and long standing problems. Other children may have lesser symptoms and may recover in lesser time. According to studies, children can definitely recover from even broad impacts of trauma with timely implemented trauma informed care and interventions. ‘Trauma informed care’ specifically addresses the special needs of children suffering from traumatic experiences.

Stats and Numbers (according to SAMHSA)

• In US over 680,000 children were abused in 2015
• 25% of high school students were involved in at least 1 physical fight
• 1 in 5 students had been bullied at school, at least 1 in 6 students experienced cyber-bullying
• About 17% of children in the age group of 12-17 years old reported being physically abused
• Over 50% of families have been impacted by some type of disaster

‘The Biological Effects of Childhood Trauma’ – this study outlines how childhood trauma has detrimental consequences on the biological stress systems, and cognitive and brain development.

Study – “Childhood trauma and chronic illness in adulthood: mental health and socioeconomic status as explanatory factors and buffers” – shows that experiences of traumatic events in childhood have been shown to have long term consequences for health in adulthood.

Another study – ‘Rethinking childhood trauma – new research directions for measurement, study design and analytical strategies’ – show that childhood trauma is a key modifiable risk factor for psychopathology.

Related Reading – “Childhood Trauma – Ayurveda Understanding”